Please eval my birth plan.

[LionessMom]

I am planning a homebirth. i am seeking an ob and writing a birth plan in case i need to transfer. so it only needs to go over stuff that could happen in case of transfer like an emergency e etc. can you look at this and tell me if i need to add or subtract stuff? the only reason i would transfer is if baby is in distress or i need an emerg c. 

My Birth Plan

mr and mrs mom and dad

due June 30th 2012.

written on May 30th 2012.

 

I prefer to deliver at local hosp.

 

I would like my husband Ben, my Doula Jill, and my friend Moira to be allowed with me at all times during labor, delivery and after. If baby needs to be away from me, i request that either Jill or Moira be allowed to go with Ben and the baby. 

During my labor i would like a dimmed quiet room with very few distraction. I do not want nurses in and out of the room, as few vaginal exams as possible, to eat and drink as I see fit (with approval by doctor), and only my doctor and the nurses present (no interns etc).

 During my Labor I would like to walk or do whatever i feel is right. I am not interested in an enema, shaving, catheter, or iv. I understand a heparin lock in preferred by the hospital and will use one if it seems needed. I would like monitoring to be intermittent. I would not like any labor augmentation or rupture of membranes. My body has done this before and it knows how. If it seems like itmight be neccessary, I would like a second opinion. If I seem in pain or uncomfortable, my Doula will provide the pain relief or distraction. I do not want pain medication in any way. Do not ask. 

During delivery, I will deliver in whatever position my body feels is needed. I will push spontanously as my body dictates, with my body's natural time frame, and maybe even catch the baby myself. 

I refuse an episiotomy. I would rather tear. If I do tear, I would prefer a local topical pain relief during repair stitches. I refuse pitocin and all other meds. If it seems to be needed, we can discuss then. 

I do not want the cord to be cut until after the placenta has naturally been birthed. Do not pull on the cord or push on my uterus. I will be keeping the placenta. If something happens and I need assistance because of bleeding or retained placenta, we will discuss the options available, unless I am dying, then medical intervention is allowed. Breastfeeding immediately after birth helps the placenta to detach. 

I want to hold and nurse my baby immediately after delivery. No one is to bathe my baby, dress my baby, or feed my baby but me. This baby will be breastfed on demand. I refuse consent to bottles, formula, sugar water, and pacifiers. There is to be no Vitamin K shot, no antibiotic eye drop or gel, no Hep B vaccine, and NO CIRCUMCISION. my BABY WILL NOT BE CIRCUMCISED. I REFUSE CONSENT. I understand the PKU test will need to be done before we leave the hospital. 

I would baby's exam to only be done after I have held him, nursed him, and birthed the placenta. His exam can be done on the bed next to me. My husband will sleep in the same room with us.

I will not need meds for after baby. I would like Baby and I to be released from the hospital as soon as possible. I have other children at home to go home to. I prefer nothing longer than a 24 hour stay. 

In case of a cesearean section: 

It is highly unlikely I will need one. In case I do it will be an emergency one. My wishes for this are:

that my husband, doula, or aforementioned friend to accompany me to the OR. I would like to remain conscious if I can. If not, the person accompanying me will be a great help to let me know what was going on and baby's first moments etc. I would prefer to see baby be born and my hads kept free so I may touch baby right away and possibly nurse right away. If I may be conscious, I would like it explained to me as it happens. I prefer my Doula, or aforementioned friend to accompany baby if he needs to be separated from me at all. the above mentioned wishes in regards to shots etc still stand. NO CIRCUMCISION! If he is not doing well then life saving meds may be administered. These do not include vaccinations. Those will be given by his pediatrician later in their office. I do not want to be separated from my baby even durig recovery from an emergency c-section. Anything administered to my baby will be discussed with me and approved by me first. I still want to keep my placenta. It can be given to my Doula Jill. 

If Baby needs to be in the NICU, he  is only to be given my breastmilk, which I will pump if needed. I will hold him when I want unless he is in serious condition. 

Medicines for me after delivery will be decided on as I judge how much pain I am in. I still would like to stay as briefly as possible.  

[katt]

It seems like you covered everything.

My advice would be to make it more of an Outline form or with Bullets to make it easier and quicker to read.

Personally I'd have a few different main categories: Do not even ask me, just do it (or not) -circ/bottles etc...- , Willing to negotiate if needed -hep lock-

I'd also look into the PKU thing, cause I know that around here at least, you can do it a few days later at your ped's and have the results be much more accurate due the fact that baby will have milk to digest.

[LionessMom]

Originally Posted by katt 

It seems like you covered everything.

My advice would be to make it more of an Outline form or with Bullets to make it easier and quicker to read.

Personally I'd have a few different main categories: Do not even ask me, just do it (or not) -circ/bottles etc...- , Willing to negotiate if needed -hep lock-

I'd also look into the PKU thing, cause I know that around here at least, you can do it a few days later at your ped's and have the results be much more accurate due the fact that baby will have milk to digest.

thanks. that does seem like it should clean it up a bit. 

PKU- i had a natural hosp birth last time. the only thing i could not get done at the ped office was the pku. i asked this time again and they said that they want to see baby within the first week and the pku test should be by the end of the week and they have to order it at the hosp. and it is required by my state law. everything else was negotiable ie did not have to do it. 

[amyjrn23]

Please understand that I am not trying to be mean or disrespectful. Thatt this is only my opinion based on my experiences. My advice may sound harsh, but please look at it as "tough love".

As a labor nurse, I can honestly say, that the majority of labor nurses and OBs would look at that birth plan, roll their eyes, and try not to laugh.

I have been a labor nurse for 11 years. I personally love taking care of NCB moms, but not all labor nurses do. You said that you are planning a home birth. So I assume that the only reason you would be in the hospital is if there were an "issue." The only way any hospital is going to be ok with a mom having a hep lock only, intermittent monitoring, and oral fluids is if she is having a completely normal, low risk labor. And if you find your self in the hospital when planning a home birth....you are no longer having a normal, low risk labor.

Keep it simple. Just say, "I am planning a hb. If for some reason I am transferred to the hospital, if possible, I would like to continue with my goal to have as minimal interventions as possible."

Then just bullet point no circ, no eyes and thighs, no formula, skin to skin asap. The problem that most health care providors have with written birth plans is that (with out meaning to) they come off as arrogant. If you say, "i am planning a minimal intervention, unmedicated birth" we know what that means. U don't have to write out intermittent monitoring, low lights, minimal vag exams ect.... With out meaning to your sending a message to the staff that they don't know they are doing. Most hospital based birth workers when presented with a 14 page birth plan would really like to say to the patient "i promise you I know more about birth in my xx years of practice, and assisting with thousands of deliveries than you learned in 9 months of reading and watching youtube videos." But they can't say that out loud....thus the hostility a lot of ncb patients feel from hospital staff. I wish out wasn't that way, believe me I do. But unfortunetly, it's reality.

Keep it short and simple. And remember that you will have a doula there so if things start happening that aren't in line with your desires and you are not in a position to stand up for your self...your doula will.

And don't ever ever ever use I phrase "i refuse" in a birth plan. It just reinforces the belief that you think your more knowledgeable about birth. For example, "i refuse an episotomy." If your babys heart rate is 50 & has been for 5 min, and your baby is crowning, and the difference between your baby riding the short bus or not is the 60 seconds faster the doc can get the baby out with an episotomy....then that is not the time to "refuse" something. Just say, unless the baby or myself are in danger I would prefer not to have an episiotomy. And if your babies blood sugar is 12, it's not a good idea to "refuse formula." Instead, you might say, "if a true medical need for supplementation becomes necessary I would request the assistance of the lactation consultant so that we may discuss a feeding plan that is least likely to interfere with breastfeeding.

Using the phrase "i would like to politely request..... Comes off better than refusing. For example, I would politely request to not be offered pain mess. I politely request that routine procedures like babys height, weight, and new born exam be delayed until the first feeding has occurred.

So this is just my 2 cents and you can take it for what it's worth. I don't mean to offend anyone, this is just 1 opinion of many from the side of the hospital worker.

I once had a ncb patient that for one reason or another was being induced with pitocin...thus continuous monitoring. Plus she had meconium and gestational diabetes thus further reason for continuous monitoring. She wrote in her birth plan that she "refused internal monitoring." She had wanted a water birth. She was somewhere around 8-9 cm when I came on and was lamenting about not being able to get in the tub. I explained to her that the external monitors are not water proof, but if she world allow me to place an internal fetal monitor she could labor and deliver in the tub. She had an amazing water birth 20 min later. After the birth she expressed how thankful she was that she was presented this option, and disappointed she wasn't offered it sooner. I reminded her of her "refusal of internal monitoring." Later the OB explained to her that she didn't offer the internal/tub option sooner because she knew how important it was to her to not have internal monitoring. She could have kicked herself when she realized she could have spent more time in the tub. The moral of the story: be flexible, be open that things might not unfold the way you want them, don't refuse anything because you never know what might happen.

[1stTimeMama4-4-10]

Originally Posted by amyjrn23 

Please understand that I am not trying to be mean or disrespectful. Thatt this is only my opinion based on my experiences. My advice may sound harsh, but please look at it as "tough love".
As a labor nurse, I can honestly say, that the majority of labor nurses and OBs would look at that birth plan, roll their eyes, and try not to laugh.
I have been a labor nurse for 11 years. I personally love taking care of NCB moms, but not all labor nurses do. You said that you are planning a home birth. So I assume that the only reason you would be in the hospital is if there were an "issue." The only way any hospital is going to be ok with a mom having a hep lock only, intermittent monitoring, and oral fluids is if she is having a completely normal, low risk labor. And if you find your self in the hospital when planning a home birth....you are no longer having a normal, low risk labor.
Keep it simple. Just say, "I am planning a hb. If for some reason I am transferred to the hospital, if possible, I would like to continue with my goal to have as minimal interventions as possible."
Then just bullet point no circ, no eyes and thighs, no formula, skin to skin asap. The problem that most health care providors have with written birth plans is that (with out meaning to) they come off as arrogant. If you say, "i am planning a minimal intervention, unmedicated birth" we know what that means. U don't have to write out intermittent monitoring, low lights, minimal vag exams ect.... With out meaning to your sending a message to the staff that they don't know they are doing. Most hospital based birth workers when presented with a 14 page birth plan would really like to say to the patient "i promise you I know more about birth in my xx years of practice, and assisting with thousands of deliveries than you learned in 9 months of reading and watching youtube videos." But they can't say that out loud....thus the hostility a lot of ncb patients feel from hospital staff. I wish out wasn't that way, believe me I do. But unfortunetly, it's reality.
Keep it short and simple. And remember that you will have a doula there so if things start happening that aren't in line with your desires and you are not in a position to stand up for your self...your doula will.
And don't ever ever ever use I phrase "i refuse" in a birth plan. It just reinforces the belief that you think your more knowledgeable about birth. For example, "i refuse an episotomy." If your babys heart rate is 50 & has been for 5 min, and your baby is crowning, and the difference between your baby riding the short bus or not is the 60 seconds faster the doc can get the baby out with an episotomy....then that is not the time to "refuse" something. Just say, unless the baby or myself are in danger I would prefer not to have an episiotomy. And if your babies blood sugar is 12, it's not a good idea to "refuse formula." Instead, you might say, "if a true medical need for supplementation becomes necessary I would request the assistance of the lactation consultant so that we may discuss a feeding plan that is least likely to interfere with breastfeeding.
Using the phrase "i would like to politely request..... Comes off better than refusing. For example, I would politely request to not be offered pain mess. I politely request that routine procedures like babys height, weight, and new born exam be delayed until the first feeding has occurred.
So this is just my 2 cents and you can take it for what it's worth. I don't mean to offend anyone, this is just 1 opinion of many from the side of the hospital worker.
I once had a ncb patient that for one reason or another was being induced with pitocin...thus continuous monitoring. Plus she had meconium and gestational diabetes thus further reason for continuous monitoring. She wrote in her birth plan that she "refused internal monitoring." She had wanted a water birth. She was somewhere around 8-9 cm when I came on and was lamenting about not being able to get in the tub. I explained to her that the external monitors are not water proof, but if she world allow me to place an internal fetal monitor she could labor and deliver in the tub. She had an amazing water birth 20 min later. After the birth she expressed how thankful she was that she was presented this option, and disappointed she wasn't offered it sooner. I reminded her of her "refusal of internal monitoring." Later the OB explained to her that she didn't offer the internal/tub option sooner because she knew how important it was to her to not have internal monitoring. She could have kicked herself when she realized she could have spent more time in the tub. The moral of the story: be flexible, be open that things might not unfold the way you want them, don't refuse anything because you never know what might happen.

This post is right on.  It is respectfully written and makes some really important points.  If, in fact, you are in the hospital, it is only because something went awry.  I had some of the same thoughts as this poster that if you need a hospital transfer that you will no longer be in a position to refuse anything because there will be some medical reason for it, and making your preferences known is definitely important, but the hospital won't allow you to refuse an IV or continuous monitoring etc. when there is a medical need for it.  By "refusing" those things right off the bat, you might be setting yourself up to have an adversarial relationship with your care providers.  I really like how this poster suggested that subtle tweaks would go a long way, and also that the birth plan be limited to 1-2 pages of bullet points.  Otherwise you run the risk of it not being read.

For what it's worth, I wrote a 5 page birth plan for my first pregnancy but ended up changing practices after I realized that I needed a 5 page birth plan to communicate my preferences to my care providers - I didn't trust them to do what I wanted without it (or with it).  I ended up changing to a midwifery run birth center and didn't even do a birth plan. I knew that either I would (A) end up birthing in the birth center exactly as I wanted to, or (B) transfer to the hospital for a significant problem and I would need to trust my midwives to advocate for me.  I ended up at the hospital, and my midwives were still able to deliver the baby and advocate for my wishes.  Now - my situation is somewhat unique because my midwives have full privileges in the hospital so I didn't need to tell them what I wanted, they knew.  But the bottom line was that I accepted that if I ended up in the hospital, I needed to be flexible and accept that my initial plan was out the window and adapt to plan B.  That is NOT to say that YOU shouldn't have a backup birth plan - only that if you end up needing it, flexibility will be your friend. 

[snugglebug14]

I agree with what the previous posters have said about the fact that if you are transferring it is due to a complication (at least that is the assumption if you are planning a home birth) and that in that case there is going to be some medical need that needs to addressed, likely requiring some form of intervention. (perhaps you want to make two birth plans....one in the event of a true emergency and one in the event of some other reason for transferring such as maternal exhaustion, a change in the desire for pain meds, or being *Truly* postdates and needing an induction). I think that in your birth plan there are several good points that I would want my care providers to be aware of in the event of a transfer (even in an emergency) but that those things, over which you should/could have control, will get lost in the mix of the things that you likely won't have control over in an emergency situation. So i would reiterate what the other posters have said and make a bullet point list of the most important things...no vax, no circ, desire to breastfeed, etc. Best of luck mama! I hope your birth goes beautiful and you won't even need your birth plan :)

[lexapurple]

 I love this post by amyjrn23. It is to the point. Most likely if you make it to the hospital it means that things are not going so good and you need interventions and in this case you would not be able to call the shots about your care. I agree with others that in case of "transfer plan" it is better to have a bullet point pla empfasising baby friendly care.

 I had one very long home birth (46 hours) and an 8hr birth at freestanding birth center. First time I assumed since I am having a homebirth with very well known and experienced midwife I don't really need a birth plan, shouldn't she know what is right? I am happy with the fact that I was able to have my DD at home but I can not say that I am happy with the experience. It would have been much better if I had a written plan and discussed it with my midwife, since her understanding of birth and what a mother needs differed from mine. 

During my second pregnancy, I wrote a birth plan (it was still two pages long) and gave it to my midwifes and we discussed what points they were able to accomodate and which not and how it would depend on situation. At the end they were able to do everything that I have asked for. 

[AmandaMamma]

Agreed that if you are transferring for complications most of the birth plan is out the window. If there is an emergency the doctor may not even give it a second look.

I'm going to be delivering at a very baby friendly hospital and asked the nurses about birth plans. They said exactly what the PP said up there. Keep it very short and simple for the best results.

[Friday13th]

I had a planned HBAC turn into a transfer and CBAC. And I was pretty sure if we were headed to the hospital, laboring in a dimly lit room with minimal interventions was no longer a concern. And I was right. We went to the hospital FOR the interventions because we were outside the scope of having a safe HB.

My birth plan was basically, please discuss our options with us as much as circumstances allow, please tell me what you're doing while you're doing it and the BIG ONES: baby stays with mom or dad at all times, BFing as soon as possible, no shots, no circ.

I had a TON of interventions I would have had on my I don't want list in a typical birth plan but when it was happening I was totally informed, made a decision I was happy with and very much felt respected and like the staff was doing everything they could to get me a vaginal birth. In the end we made the call to do the section when we did, for reasons based on our past experiences and in the end it was a choice I felt good about and I never felt any pressure to make it and that was the most important thing to me.

[LionessMom]

so nobody actually read the birth plan? bc you would have noticed it is indeed only one page, has a separate section for just if i need a csec and specific sentences referring to discuss with me but in case someone is dying then what goes is what goes. all the stuff that i say i refuse is in the normal birth section which i kept short and to the point bc i doubt i will need it if i indeed end up transferring. as for the supplementation... never necessary. i have done my research thoroughly as i had GD last time. i feel that hospital birth workers dont do as much research on birth as they should and every time i have had to deal with them, i actually knew more about bfing cosleeping and healthy birthing than they did. I am not one of those people who will blindly believe some doctor knows everything they need to know just bc they have initials after their name. same goes for nurses. the doc is there specifically for what they trained for... to save baby and my life if i need emergency help. 

for what it is worth, i delivered in the hospital last time. i had a 4 page birth plan. the doctor and all the nurses including the ones who came on shift half way through, read it. i have been advised  numerous times to use words like refuse and do not consent rather than "oh please dont" bc that makes my choices clear. i will take your advice into consideration.

eta: a doula is there to support mom, it is not in their job description around here to stand up for mom. all they can do is to mremind mom what she wanted and mom has to stand up for herself. 

[Hugh7]

As well as "no circumcision" you need "and his foreskin is NOT to be retracted, for 'cleaning' or any other reason"

[Serenity Now]

I did read the birth plan, and I agree with Amy. Also, starting out talking about shaving and enemas and stuff is not starting you out on the right foot. Those practices went out the window in the 70's.

You do need to be more flexible about medical needs that might arise. Of course you don't want to risk your baby's brain or life for an experience, and unfortunately, things can happen during birth that do turn in to life or death situations.

With my first, I read all the NCB stuff and had an adversarial birth plan similar to yours. But then, in labor I realized that a lot of what I had been told would happen to me in the evil hospital didn't. And I felt kinda betrayed, that I had spent so much time worrying about enemas and shaving and how they tie your arms down during pushing, when its just not true. for my next hospital birth I just sat down with the nurse who was in charge of me and we had a friendly chat about things I wanted and didn't want and everything was so much smoother. They felt I trusted them, and they bent over backwards to make sure that everything happened exactly the way I wanted it to happen.

[fruitfulmomma]

LionessMom... pm'ing you.

[AmandaMamma]

Originally Posted by LionessMom 

for what it is worth, i delivered in the hospital last time. i had a 4 page birth plan. the doctor and all the nurses including the ones who came on shift half way through, read it. i have been advised  numerous times to use words like refuse and do not consent rather than "oh please dont" bc that makes my choices clear. i will take your advice into consideration.

You aren't starting out in the hospital this time though. Your plan is a home birth and if you transfer it would be because baby is in distress. I meant that if it were an emergency the doctors or nurses would not have time to read paragraphs.

To me " do not consent" isn't rude and is more a clear legal like term so I can see that.

I think shortening it and bullet points is still a good idea. Especially for a baby in distress things would need to be short and to the point. I think it is good that you will have a plan though since you would be seeing doctors you have never discussed things with before.

[1stTimeMama4-4-10]

Originally Posted by LionessMom 

so nobody actually read the birth plan? bc you would have noticed it is indeed only one page, has a separate section for just if i need a csec and specific sentences referring to discuss with me but in case someone is dying then what goes is what goes. all the stuff that i say i refuse is in the normal birth section which i kept short and to the point bc i doubt i will need it if i indeed end up transferring. as for the supplementation... never necessary. i have done my research thoroughly as i had GD last time. i feel that hospital birth workers dont do as much research on birth as they should and every time i have had to deal with them, i actually knew more about bfing cosleeping and healthy birthing than they did. I am not one of those people who will blindly believe some doctor knows everything they need to know just bc they have initials after their name. same goes for nurses. the doc is there specifically for what they trained for... to save baby and my life if i need emergency help. 

for what it is worth, i delivered in the hospital last time. i had a 4 page birth plan. the doctor and all the nurses including the ones who came on shift half way through, read it. i have been advised  numerous times to use words like refuse and do not consent rather than "oh please dont" bc that makes my choices clear. i will take your advice into consideration.

eta: a doula is there to support mom, it is not in their job description around here to stand up for mom. all they can do is to mremind mom what she wanted and mom has to stand up for herself. 

I read the whole thing, and frankly, I found it off putting.  You make clear that the only reason you will need it is if you transfer to the hospital due to complications, and then you tell the doctors and nurses that you aren't interested in any of the care that they provide.  I am planning to birth in a birth center because I don't want interventions.  If that doesn't work out, it will be because I NEED interventions and I need to have at least some trust that the hospital will provide me with the best care possible.  I think you need to do the same.

I am sorry if you felt attacked, that certainly was not my intention and I don't think it was anyone else's intention, but I read lots of sentences that would be skimmed over because of the formatting, and some points that are likely to make the doctors and nurses roll their eyes at what you are asking for. The hep lock and intermittent monitoring won't happen if you are there for a serious complication, nor will the dimmed room with no distractions, nor will you be permitted to just do whatever you feel like as you state you intend to do, and you refuse absolutely all interventions.  I think that is setting you up to have a battle when what you need to do is recognize that the hospital can help you if you need their help.  

I still think bullet points are the way to go, and only ask for what you REALLY want - like exclusive breastfeeding unless there is a medical necessity, no circ, skin to skin, baby never out of your presence, no vaccinations, and most importantly, that they take the time to talk to you about any and all interventions before they occur.  

[Friday13th]

I also read the whole thing and I'm certainly not trying to be offensive, I think you just need to think "What am I really going to be going to the hospital for and how do I want them to treat me?" You aren't going there to continue a peaceful, low intervention birth. You want them on your side when you go in there so don't bombard them with things that aren't going to happen, focus on what you REALLY need from them. Make it shorter, bullet pointed and less adversarial.

[GoBecGo]

I have had 2 homebirths.  I too had a plan in case of transfer, and i too planned to transfer only for emergency.

My transfer plan was:

Quote:

Birth Plan (transfer)

If this plan is being used then i have transferred from a planned homebirth for some sort of emergent problem.

I suffer from hypothyroidism, and am currently medicated with 100mcgm/day levothyroxine.  My partner, will bring my medication.

I would like to be fully informed of what is happening and why.  My midwife and my partner will be with me, and i would like them both to remain with me.

I want to breastfeed and would like to do so as soon after birth as possible for me and the baby.  For that reason i’d like skin-to-skin as soon as possible after birth.

If the baby and i have to be separated i would like my partner to remain with the baby at all times, as far as possible.  If i am unable to, he will make medical decisions regarding our child.

If i need to have a caesarean section please do everything you can to maximise my chance of successful VBAC in the future.

I had a similar plan to yours, with the low lights etc. etc. but i discussed THAT stuff with my midwife, who was doing the birth i wanted.  I knew that if i had to transfer it would be for the birth i was getting for medical necessity.  I'm in the UK, and here there is no circ and babies are roomed in (which is why my plan doesn't mention bottles/circing) unless ill.

I think that your plan is a good BIRTH plan, but maybe not a great transfer plan.  You're not trying to get a "good" birth in the hospital, you're there to save you or the baby, so you need to think "what is my absolute back line on these things?".  If you come in for an emergent problem time is short, you won't want them reading through the things which only mattered if everything was normal anyway.

It is very unlikely you will need a transfer plan, if you do it is because something you cannot foresee is wrong.  So the plan needs to reflect that, you don't really know if you refuse pitocin, if you've lost 1500cc of blood you don't, right?  You don't know if you refuse an epidural - if you need a cs and want to be awake it's one of the options to make that happen.  But you DO know that you decline circumcision, so that's an excellent thing to leave in.

I've had 2 homebirths, and both times i had to write a plan like this.  It was really hard, after months of work planning the birth i wanted, to examine the starkness of the possibilities i COULD be facing.  I totally get why you'd want to have as close to a NCB as possible.  The stuff you list is REALLY important stuff if you're aiming for a NCB IN the hospital, but you're not.  You'll be having it at home (really, VERY likely you will be!).  So if you go in your NCB stuff is irrelevant, you won't have gone there for an NCB, but for an emergency birth.

Best of luck, i'm sure in a while you'll be looking at this, as i look at mine, remembering a wonderful homebirth and laughing at the emotions you went through writing and editing something you ended up never even needing. :D

[LionessMom]

Originally Posted by Serenity Now 

I did read the birth plan, and I agree with Amy. Also, starting out talking about shaving and enemas and stuff is not starting you out on the right foot. Those practices went out the window in the 70's.

yes, i could prob remove that part.  

Originally Posted by AmandaMamma 


You aren't starting out in the hospital this time though. Your plan is a home birth and if you transfer it would be because baby is in distress. I meant that if it were an emergency the doctors or nurses would not have time to read paragraphs.
To me " do not consent" isn't rude and is more a clear legal like term so I can see that.
I think shortening it and bullet points is still a good idea. Especially for a baby in distress things would need to be short and to the point. I think it is good that you will have a plan though since you would be seeing doctors you have never discussed things with before.

bullet points will be a good idea.

Originally Posted by 1stTimeMama4-4-10 

I read the whole thing, and frankly, I found it off putting.  You make clear that the only reason you will need it is if you transfer to the hospital due to complications, and then you tell the doctors and nurses that you aren't interested in any of the care that they provide.  I am planning to birth in a birth center because I don't want interventions.  If that doesn't work out, it will be because I NEED interventions and I need to have at least some trust that the hospital will provide me with the best care possible.  I think you need to do the same.

I am sorry if you felt attacked, that certainly was not my intention and I don't think it was anyone else's intention, but I read lots of sentences that would be skimmed over because of the formatting, and some points that are likely to make the doctors and nurses roll their eyes at what you are asking for. The hep lock and intermittent monitoring won't happen if you are there for a serious complication, nor will the dimmed room with no distractions, nor will you be permitted to just do whatever you feel like as you state you intend to do, and you refuse absolutely all interventions.  I think that is setting you up to have a battle when what you need to do is recognize that the hospital can help you if you need their help.  

I still think bullet points are the way to go, and only ask for what you REALLY want - like exclusive breastfeeding unless there is a medical necessity, no circ, skin to skin, baby never out of your presence, no vaccinations, and most importantly, that they take the time to talk to you about any and all interventions before they occur.  

i know i am not starting out in the hospital this time. but the birth plan will be filed before i go into labor. they dont know i am planning a homebirth, i am not telling them. if i transfer they will be told i had been laboring at home and decided to come in when i felt something was wrong. so the birth plan was to include reg labor stuff as well as emergency csec stuff. so all the reg labor stuff is just for show. and since i have already used this hospital (it is a birth center attached to a hosp where i would go that also does all the csecs and emergency stuff) twice i am aware of their policies already. except the ones for csecs as i have never had one. and i am not refusing interventions in case of an emergency. 

Originally Posted by GoBecGo 

I have had 2 homebirths.  I too had a plan in case of transfer, and i too planned to transfer only for emergency.

My transfer plan was:

I had a similar plan to yours, with the low lights etc. etc. but i discussed THAT stuff with my midwife, who was doing the birth i wanted.  I knew that if i had to transfer it would be for the birth i was getting for medical necessity.  I'm in the UK, and here there is no circ and babies are roomed in (which is why my plan doesn't mention bottles/circing) unless ill.

I think that your plan is a good BIRTH plan, but maybe not a great transfer plan.  You're not trying to get a "good" birth in the hospital, you're there to save you or the baby, so you need to think "what is my absolute back line on these things?".  If you come in for an emergent problem time is short, you won't want them reading through the things which only mattered if everything was normal anyway.

It is very unlikely you will need a transfer plan, if you do it is because something you cannot foresee is wrong.  So the plan needs to reflect that, you don't really know if you refuse pitocin, if you've lost 1500cc of blood you don't, right?  You don't know if you refuse an epidural - if you need a cs and want to be awake it's one of the options to make that happen.  But you DO know that you decline circumcision, so that's an excellent thing to leave in.

I've had 2 homebirths, and both times i had to write a plan like this.  It was really hard, after months of work planning the birth i wanted, to examine the starkness of the possibilities i COULD be facing.  I totally get why you'd want to have as close to a NCB as possible.  The stuff you list is REALLY important stuff if you're aiming for a NCB IN the hospital, but you're not.  You'll be having it at home (really, VERY likely you will be!).  So if you go in your NCB stuff is irrelevant, you won't have gone there for an NCB, but for an emergency birth.

Best of luck, i'm sure in a while you'll be looking at this, as i look at mine, remembering a wonderful homebirth and laughing at the emotions you went through writing and editing something you ended up never even needing. :D

i think i will make the one to be filed at the hospital/birth center and backup ob first so i can get it handed in. i already preregistered to cut down on stuff like ins paperwork. then i will make a second that only lists transfer stuff. it will be the same as on the original but not include the reg labor stuff. that way if i go in then can have a quick sheet to look at instead of having to look through the sections to find the one labeled csec and baby care. i know from experience that they look at your paperwork when you come in or right after you call saying you are coming in. 

i should have prob responded individually last time. i only got a little upset bc it seemed like no one knew where i was going with this and it is my fault bc i didnt explain it enough. a DEM assisted homebirth is illegal in my state. an unassisted is not. so if i transfer there will be no telling them i had planned to deliver at home with a DEM. that is why the plan has 2 sections. one for the reg birth and one for an emergency that i will file before birth. 

[LionessMom]

this is the next draft. this shows up on 2 pages with bulleting but it does not transfer over and i cant attach attachments. i included the header on the second page above the csec thing so that i can print it out separate later. 

 

eta: i didnt change the wording of anything. all i did was remove some stuff and add some stuff and make it more of a list.   

 

 

My Birth Plan

Jennifer Brade and Benjamin Brade

due June 30th 2012.

 

I would like my husband Ben Brade, my Doula Jill, and my friend Moira to be allowed with me at all times during labor, delivery and after. If baby needs to be away from me, i request that either Jill or Moira be allowed to go with Ben and the baby. 

 

 During Labor:

 I would like to walk or do whatever i feel is right. 

Dimmed quiet room with very few distraction and only my doctor and the nurses present (no interns etc).

I am not interested in an IV. I understand a heparin lock is preferred by the hospital and will use one if it seems needed. 

Intermittent monitoring. 

No labor augmentation or rupture of membranes. If it seems like it might be neccessary, I would like a second opinion. 

If I seem in pain or uncomfortable, my Doula will provide the pain relief or distraction. I do not want pain medication in any way. Do not ask. 

During delivery:

I will deliver in whatever position my body feels is needed. I will push spontanously as my body dictates, with my body's natural time frame, and maybe even catch the baby myself. 

I refuse an episiotomy.  I have Ehlers-Danlos Syndrome Hypermobility Type, this increases the risk of tear after an episiotomy. It is safer for me to tear. If I do tear, I would prefer a local topical pain relief during repair stitches, please take care repairing stitches because of my skin issue. I refuse pitocin and all other meds. If it seems to be needed, we can discuss then. 

I do not want the cord to be cut until after the placenta has naturally been birthed. Do not pull on the cord or push on my uterus. 

I will be keeping the placenta. 

If something happens and I need assistance because of bleeding or retained placenta, we will discuss the options available, unless I am dying, then medical intervention is allowed.

Baby Care:

I want to hold and nurse my baby immediately after delivery. No one is to bathe my baby, dress my baby, or feed my baby but me. This baby will be breastfed on demand. 

I refuse consent to bottles, formula, sugar water, and pacifiers. There is to be no Vitamin K shot, no antibiotic eye drop or gel, no Hep B vaccine, and NO CIRCUMCISION. my BABY WILL NOT BE CIRCUMCISED. I REFUSE CONSENT. Do not retract his foreskin for any reason.  I understand the PKU test will need to be done before we leave the hospital. 

I would like baby's exam to only be done after I have held him, nursed him, and birthed the placenta. His exam can be done on the bed next to me. 

I will not need meds for after baby. I would like Baby and I to be released from the hospital as soon as possible. I have other children at home to go home to. I prefer nothing longer than a 24 hour stay. I have discussed all of this with his own doctor.

 

 

 

My Birth Plan

Jennifer Brade and Benjamin Brade

due June 30th 2012.

 

In case of a cesearean section: 

It is highly unlikely I will need one. In case I do it will be an emergency one. My wishes for this are:

My husband, doula, or aforementioned friend will accompany me to the OR. I would like to remain conscious. If not, the person accompanying me will be a great help to let me know what was going on and baby's first moments etc. I would prefer to see baby be born and my hands kept free so I may touch baby right away and possibly nurse right away. If I may be conscious, I would like it explained to me as it happens. 

I have Ehlers-Danlos Syndrome Hypermobility Type, please stitch me up with care. I run a higher risk of stitches tearing out. No staples. 

I prefer my Doula, or aforementioned friend to accompany baby if he needs to be separated from me at all. 

NO CIRCUMCISION! Do not retract the foreskin for any reason! If he is not doing well then life saving meds may be administered. These do not include vaccinations. Those will be given by his pediatrician later in their office. I do not want to be separated from my baby even during recovery from an emergency c-section. Anything administered to my baby will be discussed with me and approved by me first. 

I still want to keep my placenta. It can be given to my Doula Jill. I have filled out the paperwork to keep this. 

If Baby needs to be in the NICU, he  is only to be given my breastmilk, which I will pump if needed. I want to remain with my baby and hold my baby as I can.

Medicines for me after delivery will be decided on as I judge how much pain I am in. I still would like to stay as briefly as possible.  

[fruitfulmomma]

Two plans is a good idea, given your circumstances. In all likelyhood you are going to have no problems, but it is good to be prepared.

I have Ehlers-Danlos Syndrome Hypermobility Type, please stitch me up with care. I run a higher risk of stitches tearing out. No staples.

Do they have this on record? I would make sure they do plus highlight it on your birth plan and make sure both your husband and doula know that they need to communicate it to the surgeon and/or nurses so that everyone is clear on the issue in the case of an emergency where you are unable to discuss this with them.